AHIP Medicare Training Module 1 Final
Review 2025
What impact, if any, have recent regulatory changes had upon Medigap plans?
A. The Part A deductible is no longer covered under Medigap plans for all enrollees starting
January 1, 2020.
B. The Part A deductible is no longer covered for individuals newly eligible for Medicare
starting January 1, 2020.
C. The Part B deductible is no longer covered for individuals newly eligible for Medicare
starting January 1, 2020.
D. The Part B deductible is now covered for some newly eligible individuals depending on
their financial status. - ANSWER>>C. The Part B deductible is no longer covered for individuals
newly eligible for Medicare starting January 1, 2020.
Explanation: Starting January 1, 2020, Medigap plans sold to individuals who are newly eligible
to Medicare are no longer allowed to cover the Part B deductible. If an individual already had
one of the plans before January 1, 2020, they can keep their plan. If an individual was eligible
for Medicare before January 1, 2020, but are not yet enrolled, he or she may be able to
purchase one of these plans.
Mrs. Geisler's neighbor told her she should look at her Part D options during the annual
Medicare enrollment period because features of Part D might have changed. Mrs. Geisler can't
remember what Part D is so she called you to ask what her neighbor was talking about. What
could you tell her?
A. Part D covers hospital and home health services and the cost-sharing has changed this year.
B. Part D covers physician and non-physician practitioner services and the deductible has not
changed this year, but the physician charges may go up.
C. Part D covers prescription drugs and she should look at her premiums, formulary, and
costsharing among other factors to see if they have changed.
D. Part D covers long-term care services and she shouldn't worry because there has been
no change in coverage. - ANSWER>>C. Part D covers prescription drugs and she should look at
her premiums, formulary, and cost-sharing among other factors to see if they have changed.
Explanation: Part D provides prescription drug coverage. Premiums, plan formularies, and
costsharing, among other factors, may change from one plan year to another.
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being
successfully treated for that condition. However, she and her physicians feel that after her
, lengthy hospital stay she will need a month or two of nursing and rehabilitative care. What
should you tell them about Original Medicare's coverage of care in a skilled nursing facility?
A. Medicare will cover an unlimited number of days in a skilled-nursing facility, as long as a
physician certifies that such care is needed.
B. Mrs. Shields will have to apply for Medicaid to have her skilled nursing services covered
because Medicare does not provide such a benefit.
C. Once she has expended her liquid assets, Medicare will cover 80% of Mrs. Shield's long-
term care costs.
D. Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20
days of her stay, after which she would have a copay until she has been in the f - ANSWER>>D.
Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20 days of
her stay, after which she would have a copay until she has been in the facility for 100 days.
Explanation: Mrs. Shields has experienced a long hospital stay, over the 3-day time period to
qualify for skilled nursing and rehabilitative care benefits under Medicare.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be
hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an
inpatient psychiatric hospital stay that Medicare will cover?
A. Medicare inpatient psychiatric coverage is limited to the same number of days covered for
typical inpatient stays.
B. Inpatient psychiatric services are not covered under Original Medicare.
C. Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's
entire lifetime.
D. Medicare will cover, at its allowable amount, as many stays as are needed throughout Mr.
Rainey's life, as long as no single stay exceeds 190 days. - ANSWER>>C. Medicare will cover a
total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
Explanation: Medicare Part A provides coverage for inpatient psychiatric care for up to 190
lifetime days.
Mr. Buck has several family members who died from different cancers. He wants to know if
Medicare covers cancer screening. What should you tell him?
A. Medicare covers treatments for existing disease, injury, and malformed limbs or body
parts. As such, it does not cover any screening tests and these must be paid for by the
beneficiary outof-pocket.
B. Medicare covers all screening tests that have been approved by the FDA on a frequency
determined by the treating physician.
C. Medicare covers the periodic performance of a range of screening tests that are meant
to provide early detection of disease. Mr. Buck will need to check specific tests before
obtaining them to see if they will be covered.
Review 2025
What impact, if any, have recent regulatory changes had upon Medigap plans?
A. The Part A deductible is no longer covered under Medigap plans for all enrollees starting
January 1, 2020.
B. The Part A deductible is no longer covered for individuals newly eligible for Medicare
starting January 1, 2020.
C. The Part B deductible is no longer covered for individuals newly eligible for Medicare
starting January 1, 2020.
D. The Part B deductible is now covered for some newly eligible individuals depending on
their financial status. - ANSWER>>C. The Part B deductible is no longer covered for individuals
newly eligible for Medicare starting January 1, 2020.
Explanation: Starting January 1, 2020, Medigap plans sold to individuals who are newly eligible
to Medicare are no longer allowed to cover the Part B deductible. If an individual already had
one of the plans before January 1, 2020, they can keep their plan. If an individual was eligible
for Medicare before January 1, 2020, but are not yet enrolled, he or she may be able to
purchase one of these plans.
Mrs. Geisler's neighbor told her she should look at her Part D options during the annual
Medicare enrollment period because features of Part D might have changed. Mrs. Geisler can't
remember what Part D is so she called you to ask what her neighbor was talking about. What
could you tell her?
A. Part D covers hospital and home health services and the cost-sharing has changed this year.
B. Part D covers physician and non-physician practitioner services and the deductible has not
changed this year, but the physician charges may go up.
C. Part D covers prescription drugs and she should look at her premiums, formulary, and
costsharing among other factors to see if they have changed.
D. Part D covers long-term care services and she shouldn't worry because there has been
no change in coverage. - ANSWER>>C. Part D covers prescription drugs and she should look at
her premiums, formulary, and cost-sharing among other factors to see if they have changed.
Explanation: Part D provides prescription drug coverage. Premiums, plan formularies, and
costsharing, among other factors, may change from one plan year to another.
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being
successfully treated for that condition. However, she and her physicians feel that after her
, lengthy hospital stay she will need a month or two of nursing and rehabilitative care. What
should you tell them about Original Medicare's coverage of care in a skilled nursing facility?
A. Medicare will cover an unlimited number of days in a skilled-nursing facility, as long as a
physician certifies that such care is needed.
B. Mrs. Shields will have to apply for Medicaid to have her skilled nursing services covered
because Medicare does not provide such a benefit.
C. Once she has expended her liquid assets, Medicare will cover 80% of Mrs. Shield's long-
term care costs.
D. Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20
days of her stay, after which she would have a copay until she has been in the f - ANSWER>>D.
Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20 days of
her stay, after which she would have a copay until she has been in the facility for 100 days.
Explanation: Mrs. Shields has experienced a long hospital stay, over the 3-day time period to
qualify for skilled nursing and rehabilitative care benefits under Medicare.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be
hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an
inpatient psychiatric hospital stay that Medicare will cover?
A. Medicare inpatient psychiatric coverage is limited to the same number of days covered for
typical inpatient stays.
B. Inpatient psychiatric services are not covered under Original Medicare.
C. Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's
entire lifetime.
D. Medicare will cover, at its allowable amount, as many stays as are needed throughout Mr.
Rainey's life, as long as no single stay exceeds 190 days. - ANSWER>>C. Medicare will cover a
total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
Explanation: Medicare Part A provides coverage for inpatient psychiatric care for up to 190
lifetime days.
Mr. Buck has several family members who died from different cancers. He wants to know if
Medicare covers cancer screening. What should you tell him?
A. Medicare covers treatments for existing disease, injury, and malformed limbs or body
parts. As such, it does not cover any screening tests and these must be paid for by the
beneficiary outof-pocket.
B. Medicare covers all screening tests that have been approved by the FDA on a frequency
determined by the treating physician.
C. Medicare covers the periodic performance of a range of screening tests that are meant
to provide early detection of disease. Mr. Buck will need to check specific tests before
obtaining them to see if they will be covered.
